dr. nancy kay: speaking for spot
While veterinary medicine has improved the quality of life for our best friends afflicted with cancer, for pet parents, dealing with the diagnosis can be a difficult hurdle to climb. No one knows this better than veterinarian Dr. Nancy Kay. After three months of conflicting opinions with her doctor about her own suspected cancer (which thankfully turned out to be just a scare), she learned valuable lessons about the process of being a medical advocate – whether for yourself or your loved ones.
In this article reprinted from the "Survival" issue of fetch! magazine, Dr. Nancy Kay offers tips for helping pets survive even the toughest medical battles with an exclusive excerpt from her highly acclaimed book, Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life:
By now, I'll bet I've worked with a few thousand people as they've struggled with whether or not to treat their dog's cancer. They've taught me great deal that can help make this significant decision a bit easier for others. I'm passing along a few of the more important things I've learned with the hope that they will help get you on a path that's right for you and your dog.
Remember, you can call it quits at any time!
When you agree to start, remind yourself that you are not signing a contract stipulating that you will continue treatment, no matter what. When you say, "Yes," to chemotherapy or radiation therapy, all you are committing to is the very next treatment. If your dog is becoming an emotional wreck, getting worse rather than better, or experiencing negative side effects, simply speak up and say that it's time to consider a different strategy. Here's the bottom line: if ever you don't like what you see, you can call it a day. Sometimes, simply knowing that this "out clause" exists gives people the wherewithal to give cancer therapy a try.
Keep things in perspective.
Just because we can't cure a particular type of cancer doesn't mean it's not treatable. We treat lots of dogs with incurable, life-threatening diseases for the plain and simple reason that therapy often restores an excellent quality of life.
Take for example a dog with congestive heart failure. He'll never be cured of his disease and achieve his normal life expectancy, but medication has great potential to restore the quality of his life for a month to years. Treating cancer isn't all that different. Yes, for most people "cancer" sounds scarier than "heart failure," but each has the potential for a successful outcome with treatment. When it comes to survival times, don't forget to think in terms of "dog years" rather than human years. When your vet tells you that treating the cancer might buy another year of good quality time, consider that a year represents 10 percent of a 10-year-old dog's life! With that perspective, an extra year might sound like a tremendous proposition.
Focus on the quality rather than the quantity of life.
When I counsel people about the potential pros and cons of treatment, I describe the three goals of cancer therapy as, "Quality of life, quality of life, and quality of life." There's no doubt in my mind that we have failed our patient enormously when we achieve "quantity" (longer life) only.
Enjoy the "honeymoon."
Speaking of quality of life, even if your dog is doing fabulously well, it may be tough for you to 'enjoy his company when your mind is preoccupied with sadness and worry about the fact that your dog has cancer. Your happy, playing, wagging pup doesn't vanish just because cancer cells live in his body. He doesn't know he has cancer; he gets off easy when it comes to enjoying life and staying "in the moment." Let him serve as your psychological role model. Get the emotional support you need to take pleasure in the extra quality time you have with your dog. By the way, if he is acting glum, he may be responding to the way his favorite human is feeling!
Hope for the best, prepare for the worst.
Veterinarians who have treated a good deal of cancer become relatively adept at predicting how their patients will fare. But, every one of us readily admits that we encounter some dogs that surprise the heck out of us. We've all had patients who crashed when we least expected it. Likewise, we've all witnessed recoveries that feel more like minor miracles than responses to our treatment. It just goes to show you that not every dog reads the cancer textbook! Truth be told, rarely can veterinarians look their clients in the eye and tell them that things are utterly hopeless. We simply don't know for sure how anyone of our patients is going to respond.
So what's the take-home message here? I'm encouraging you to incorporate "hope" in all of your thoughts, feelings, and decisions about your dog's cancer. At the same time, avoid letting hope prevent you from recognizing when it is the end of the line. Your denial at this critical time might deprive your dog comfort and compassion at his time of greatest need.
As always, do your best to satisfy your peace of mind.
There's no doubt that you and your veterinarian want what's best for your dog. The problem is, when it comes to treating cancer, it may be impossible to know what that is. When faced with this situation, I recommend that you base your decision, at least in part, on what best contributes to your peace of mind. I'm not suggesting that you ignore your dog and think only of your own needs. Rather, I feel this is just one more approach for tackling your decision-making dilemma.
Consider the following example: If your dog has been diagnosed with terminal cancer, the unfortunate certainty is that, barring any other catastrophic events or illnesses, his disease will ultimately be what ends his life. If treatment is successful, the length of remission time is anyone's guess.
Should you treat his cancer aggressively, conservatively, or not at all? If you are unsure, I encourage you to try this mental exercise. Think about how the worst-case scenario for each of your options would play out in terms of your peace of mind. If you forego therapy and are at the brink of euthanasia in a month, will you be kicking yourself, wishing that you had pursued treatment? Likewise, if treatment was tried and failed a month later, would you have regret?
When you consider all of these worst-case scenarios, which one would allow you the greatest peace of mind? Which will keep you awake at night? When I work through this exercise with my clients, I sometimes see an expression of relief wash over their face as they finally experience some clarity about how to proceed.
Follow your own heart.
By encouraging you to follow your own heart, I'm recommending you stay true to your own values and feelings about dealing with your dog's cancer. Do your best to avoid being influenced by those who express shock when they learn that you are contemplating treating your dog's cancer. They may tell you that the appropriate treatment for cancer is "putting the poor dog out of his misery." And, when they find out how much you might be paying to have your dog treated ... well, it's probably best to avoid telling them in the first place how much you might have to spend!
Likewise, avoid those people who think that all dogs must be treated as aggressively as possible for anything and everything. I encourage you to wear a thick skin around such "influential" people (maybe take a sabbatical from socializing with them).
Provide yourself with plenty of open-minded friends who are interested in supporting you, rather than influencing you, as you wrestle with your decision. Remember, you know better than anyone else what is right for you and your best buddy.
Here is a "starter list" of definitions for some common cancer lingo:
Tumor, mass, neoplasm: all three terms are synonymous. They refer to an abnormal proliferation of cells that develops in spite of regulatory systems in the body designed to keep this cellular replication in check.
Biopsy: the collection and microscopic examination of a solid tissue sample.
Cytology: the examination of cells or fluid under the microscope.
Benign versus malignant: Benign tumors are good guys because they don't invade the surrounding structures or spread to other sites in the body. A malignant tumor often invades into surrounding structures, interfere with normal organ function, and spread to other sites in the body via blood or lymphatic vessels. A benign tumor generally offers the better prognosis, but this isn't a guarantee.
Cancer: a tumor that is malignant.
Primary tumor: the original tumor as opposed to one that has spread from another site.
Metastasis: the spread of cancer from the primary site to secondary sites elsewhere in the body.
Sarcomas: malignant cancers arising from the supportive tissues within the body (bone, fat, cartilage, muscle fibrous tissue, blood, lymph).
Carcinomas: malignant tumors that originate from epithelial cells (cells that provide the lining of various organs and glands and also comprise part of the skin).
Leukemia: a cancer comprised of blood cells that originate within the bone marrow, then circulate within the bloodstream.
Paraneoplastic syndrome: a disturbance caused by the cancer in parts of the body that are seemingly unrelated to the cancer site.
Chemotherapy: the use of chemicals (drugs) to treat cancer.
Radiation therapy (radiotherapy): the use of a focused beam of radiation to kill cancer cells.
Remission: a decrease in cancer size in response to treatment.
Staging: A thorough evaluation of the patient to determine the aggressiveness and extent of the cancer, both where the primary tumor was found as well as at other sites throughout the body.
Oncology: the branch of medicine that deals with the study and treatment of cancer.
Veterinary oncologist: a board certified veterinary specialist whose practice centers on the diagnosis and treatment of cancer.
Questions to Ask Your Vet about Diagnosing Your Dog's Cancer
1. Is there a need for urgent decision-making?
2. What are all of the options for getting a diagnosis?
3. For each option, what is the likelihood that the test results will provide a diagnosis?
4. What are the potential risks and benefits of each of the options?
5. What is your level of experience with each of the diagnostic tests?
6. What is the cost of the diagnostic tests you are recommending?
Questions to Ask Your Vet about Staging Your Dog's Cancer
1. Is there a need for urgent decision-making?
2. What staging tests/procedures do you recommend?
3. What are the potential risks and benefits of each staging procedure?
4. Which procedures will likely produce results that will determine the prognosis?
5. Which procedures will likely produce results that will affect your treatment recommendations?
6. What is your level of experience with the staging tests you described?
7. What is the cost of the staging tests/procedures you recommended?
8. What are the costs of the potential treatment options?
Tests Commonly Used to Diagnose Cancer
1. Physical examination
2. Blood tests (complete blood cell count (CBC), chemistry profile)
4. Imaging studies
7. CT scan
8. MRI scan
10. Fine needle aspiration
11. Biopsy (tissue sample obtained with or without surgery)
From Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life by Dr. Nancy Kay. Reprinted with permission from Trafalgar Square Publishing. Copyright© 2008 by Nancy Kay. To read more from Speaking for Spot, visit www.speakingforspot.com.
Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog's Best Health: A Dozen Reasonable Things to Expect From Your Vet
Spot’s Blog: http://www.speakingforspot.com/blog